Managing Patients in the Emergency Department

The Oregon Chapter of the American College of Emergency Physicians has created a set of guidelines regarding the use of opioids in a hospital emergency department (ED). The following is a modified summary of those guidelines. Emergency medical providers (EMPs) should be supported and should not be subject to adverse consequences by any regulating bodies when respectfully adhering to these guidelines.

Only one medical professional should provide all opioids to treat a patient’s chronic pain, to the
extent possible.

The administration of intravenous and intramuscular opioids in the ED for the relief of acute exacerbations of chronic pain is discouraged.

EMPs should not provide replacement prescriptions for controlled substances that were lost, destroyed,
or stolen.

EMPs should not provide replacement doses of methadone for patients in a methadone treatment program.

Long-acting or controlled-release opioids (e.g., oxycodone, fentanyl patches, and methadone) should not be prescribed by EMPs.

EMPs should exercise caution when considering prescribing opioids for patients who present to the ED without a government-issued photo ID.

Primary care and pain-management physicians should make patient pain agreements accessible to local EDs and work to include a plan for pain treatment in the ED.

EDs should coordinate the care of patients who frequently visit the ED, using an ED care coordination program, to the extent possible.

The administration of meperidine in the ED is discouraged.

ED prescriptions for opioid pain medication for acute injuries should be no more than 10 pills. For more serious injuries (fractured bones), the amount prescribed should be an amount that will last until the patient is reasonably able to receive follow-up care for the injury. In most cases, this should not exceed 20 tablets.

EMPs are encouraged to ask patients about past or current substance abuse prior to the EMP prescribing opioid medication for acute pain. Prescribe opiates with great caution in the context of substance abuse.

EMPs are required by law to evaluate an ED patient who reports pain to determine whether an emergency medical condition is present. If an emergency medical condition is present, the EMP is required to stabilize the patient’s condition. The law allows the EMP to use his or her clinical judgment when treating pain and does not require the use of opioids.